Pennsylvania Department of Health
WESLEY ENHANCED LIVING AT STAPELEY
Patient Care Inspection Results

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WESLEY ENHANCED LIVING AT STAPELEY
Inspection Results For:

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WESLEY ENHANCED LIVING AT STAPELEY - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:

Based on an Abbreviated Survey in response to a complaint completed on April 9, 2024, it was determined that Wesley Enhanced Living at Stapeley was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations as they relate to the Health portion of the survey process.









 Plan of Correction:


483.25(l) REQUIREMENT Dialysis:This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.
483.25(l) Dialysis.
The facility must ensure that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences.
Observations:

Based on clinical record review, interviews with staff and review of policies and procedures, it was determined that the facility failed to ensure that medications were administered according to professional standards of practice before and during dialysis treatment for one of two residents on hemodialysis.(Resident R1)

Findings include:

Review of the facility policy titled administering medication dated April, 2019 revealed that licensed nursing staff were required to administer medications to the residents in a safe and timely manner as prescribed by the physician.
The policy also indicated that the administration of medications was supervised by the director of nursing services. This policy indicated that medications were required to be administered within on hour of their prescribed time. The policy said that a licensed individual administering the medication would be required to record in the medication administration record the date and time that the medication was administered. This administration would then require the signature of the licensed nurse that gave the drug.

Review of Resident R1's physician's progress note dated April 4, 2024 revealed the diagnoses of end-stage renal disease (kidney failure) pseudoseizure disorder (epileptic seizures) and hypotension (low blood pressure) . The physician indicated that hemodialysis s(a machine that filters wastes, salts and fluids from the body when the kidneys are no longer able to do this) treatments were ordered routinely (three times a week).

Clinical record review revealed that the physician had ordered medications to be administered during the months of March and April, 2024 for Resident R1. The physician had ordered Levetiracetam (used to treat pseudoseizure disorder) 500 milligrams (mg) twice a day at 8:00 a.m. and 9:00 p.m., daily and Carvedilol (used to treat cardiovascular disease) 6.25 mg to be administered at the breakfast and evening meal daily. The physician had also ordered that levetiracetam medication be sent with Resident R1 to the dialysis center on Tuesday, Thursday and Saturday for administration at the dialysis center.

Interview with the Director of Nursing, Employee E2 and Licensed nursing staff, Employees E3 and E4, at 1:00 p.m., on April 9, 2024 confirmed that Resident R1 left the facility at 9:00 a.m., for the dialysis center on Tuesdays, Thursdays and Saturdays three times weekly for hemodialysis care. The nursing staff also reported that Resident R1 returned from the dialysis center after hemodialysis treatments at 3:00 p.m. weekly.

Review of Resident R1's March, 2024 Medication Administration Record revealed that the nursing staff were administering medication (levetiracetam 500mg) at 9:00 a.m, on Tuesday, Thursday and Saturday for Resident R1. The medication administration record for March, 2024 also indicated that the nursing staff were giving Resident R1 500 mg of Levetiracetam to bring to dialysis for administration at the dialysis center on March 5, 7, 12, 14, 19, 21, 26, 28, and 30, 2024.

The medication administration record for April, 2024 was reviewed and revealed that Resident R1 was administered medication Levetiracetam 500 mg at 9:00 a.m., on March 2, 2024. The medication administration record also indicated that Resident R1 was given 500 mg of Levetiracetam to bring with him to the dialysis center.

Interview with Licensed nurse, Employee E3, at 10:30 a.m., on April 9, confirmed that Resident R1 was entrusted to bring the Levetiracetam 500 mg to the dialysis center three times a week to give to the dialysis staff. Further interview with Licensed practical nurse, Employee E3 confirmed that Resident R1 was entrusted with the safekeeping and transport of this medication from the nursing home to the dialysis unit three times a week. The licensed nurse, Employee E3 also confirmed that Resident R1 had not been assessed or care planned for the ability to self-administer medications or transport medications to the dialysis center three times a week.

Nursing progress notes on March 19, 2024 indicated that Resident R1 was sent to the hospital in the morning from the dialysis unit because upon arrival to the dialysis center Resident R1 presented with experiencing a pseudoseizure.

Nursing progress notes on April 5, 2024 indicated that Resident R1 refused to take all medications. There was no documentation to indicate that the director of nursing or the physician were notified of the resident's refusal of all medications. The resident refused the 9:00 a.m., levetiracetam (used to treat pseudo seizure disorder) and 9:00am., carvedilol (used to treat cardiovascular disease). Resident R1 was transported to the dialysis center on April 5, 2024 for hemodialysis treatment. Review of nursing note dated April 5, 2024 revelaed that the resident was transferred from the dialysis center to the hospital on April 5, 2024 due to signs and symptoms of unresponsiveness and syncope.

Interview with Employee E2, Director of Nursing, at 10:00 a.m., on April 9, 2024 revealed that there were no policies and procedures collaborated with the dialysis center to ensure that Resident R1 was arriving to the dialysis center with the 500 mg of Levetiracetam. The Director of Nursing was not assured that Resident R1 was receiving this medication or holding on to the medication to use at another time .

Interview with Employee E2, Director of Nursing at 11:00 a.m., on April 9, 2024 revealed that the facility and dialysis center had no record of what was happening with the medication Levetiracetam that was supposed to be delivered by the resident to the dialysis center during the entire months of March and April, 2024. The Director of Nursing, Employee E2, confirmed during an interview at 11:30 a.m., that the facility failed to ensure that Resident R1 received medications as ordered by the physician during the months of March and April, 2024, according to professional standards of practice for safe administration and security of medications on hemodialysis days.

28 PA. Code 211.12(b)(c)(d)(1)(2)(3)(5) Nursing services

28 PA. Code 211.10(a)(c)(d) Resident care policies

28 PA. Code 211.9(a)(1)(b)(c)(d) Pharmacy services

28 PA. Code 201.21(c) Use of outside resources

28 PA. Code 201.18(b)(1)(3) Management




 Plan of Correction - To be completed: 05/02/2024

A. Resident R1 had a medication change and med will now be given at the community.
B. Medication orders for all Residents receiving dialysis were reviewed for any self-administrated medications.
C. Nurses were re-in serviced regarding the policy for Resident self-administration of medications.
D. Audits of all Residents receiving dialysis will be reviewed weekly x 4, monthly x 2 with results being reported thru community QUAPI/SQAPE programs.


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